Squamous cell carcinoma is a major histological type of esophageal cancer in Asian countries, accounting for over 90%. Esophageal adenocarcinoma, commonly accompanied by Barrett’s esophagus is rare in our countries. However, recent data from Japan revealed that the incidence of esophageal adenocarcinoma slowly and gradually increased. Esophageal adenocarcinoma commonly presents as an elevated lesion, Type 0-IIa in the Paris classification. The lesions are commonly located between the 1 o’clock and 5 o’clock positions. The reasons could be explained by the asymmetric distribution of esophageal acid exposure. The Western guidelines recommend the Seattle protocol, 4-quadrant random biopsy taken every 2 cm. However, adherence to the protocol was insufficient owing to some concerns in the protocol. Thus, the latest trend is toward advanced imaging techniques, image enhanced endoscopy (IEE). narrow band imaging (NBI) can enhance mucosal patterns in BE. The acetic acid targeted biopsy is mainly developed in European countries. After 2.5% acetic acid was sprayed, a targeted lesion is visualized as focal loss of acetowhitening. Both are reported to be suitable for dysplasia detection in BE. Moreover, magnifying endoscopy with NBI was utilized to differentiate non-dysplastic from dysplastic lesion in the Barrett's esophagus. BING (Barrett international group) classification and Japan esophageal society classification are useful to predict the histology of the lesion. IEE aids in the detection of esophageal adenocarxcinoma and differentiation between non-dysplastic and dysplastic lesions. Further studies are warranted to accumulate the evidence of IEE.